Provider Demographics
NPI:1801334834
Name:HARDEN, STACEY NICOLE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:NICOLE
Last Name:HARDEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9785 CORSSHILL BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222
Mailing Address - Country:US
Mailing Address - Phone:904-772-6522
Mailing Address - Fax:904-772-6553
Practice Address - Street 1:101 W 48TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-5232
Practice Address - Country:US
Practice Address - Phone:049-557-5759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9282390363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner